The Outcomes of Vitrified Oocytes Accumulation for Managing Diminished Ovarian Reserve: A retrospective cohort study

Abstract Background: Vitrified M-II oocytes accumulation strategy for later simultaneous insemination has been used for managing POR. Our study aimed to determine whether simulation insemination of vitrified oocytes accumulation strategy improves live birth rate (LBR) for managing diminished ovarian reserve (DOR).Methods: Retrospective study included 440 women with DOR fulfilling Poseidon classification groups 3 and 4, defined as presence of serum anti-Müllerian hormone (AMH) hormone level <1.2 ng/ml or antral follicle count (AFC) <5, from January 1, 2014 to December 31, 2019 in a single department. Patients underwent accumulation of vitrified oocytes (DOR-Accu) and embryo transfer (ET) or controlled ovarian stimulation (COS) using fresh oocytes (DOR-fresh) and ET. Primary outcomes were LBR per ET and cumulative LBR (CLBR) per intention to treat (ITT). Secondary outcomes were clinical pregnancy rate (CPR) and miscarriage rate (MR).Results: 211 patients underwent simultaneous insemination of vitrified oocytes accumulation and ET in DOR-Accu group (maternal age: 39.29 ± 4.23 y, AMH: 0.54 ± 0.35 ng/ml), and 229 patients underwent COS and ET in DOR-fresh group (maternal age: 38.07 ± 3.77 y, AMH: 0.72 ± 0.32 ng/ml). CPR in DOR-Accu group were similar in DOR-fresh group (27.5% vs. 31.0%, p = 0.418). MR was statistically higher (41.4% vs. 14.1%, p = 0.001) while LBR per ET was statistically lower (15.2% vs. 26.2%, p < 0.001) in DOR-Accu group. There is no difference in CLBR per ITT between groups (20.4% vs. 27.5%, p = 0.081). Clinical outcomes were categorized in four groups with regard to patient’s age in secondary analysis. CPR, LBR per ET, and CLBR did not improved in DOR-Accu group. In group of 31 patients, accumulated vitrified metaphase II (M-II) oocytes reach total number ≥15, CPR improved among DOR-Accu group (48.4% vs. 31.0%, p = 0.054); however, higher MR (40.0% vs. 14.1%, p = 0.03) resulted similar LBR per ET (29.0% vs. 26.2%, p = 0.738).Conclusions: Vitrified oocytes accumulation for managing DOR did not improve LBR. Higher MR resulted in lower LBR. Vitrified oocytes accumulation strategy for managing DOR is not clinically practical.Trial registration: The study protocol was retrospectively registered and was approved by Institutional Review Board of Mackay Memorial Hospital (21MMHIS219e) on August 26, 2021